Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation An international analysis of high-cost patients. Peer-Reviewed Article July 2018
Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies Overcoming barriers to patient engagement. Peer-Reviewed Article August 2018
Home and Community-Based Services Coordination for Homebound Older Adults in Home-Based Primary Care Meeting the needs of older adults who are homebound. Peer-Reviewed Article October 2018
How ACOs Are Caring for People with Complex Needs An analysis of the National Survey of ACOs Brief/Report December 2018
Interventions for Frequently Hospitalized Patients and Their Effect on Outcomes: A Systematic Review Mixed evidence for efforts to reduce rehospitalizations. Peer-Reviewed Article December 2018
Blueprint for Complex Care: Advancing the Field of Care for Individuals with Complex Health and Social Needs This resource outlines the current state of complex care and recommendations for the future. Implementation Tool December 2018
Patterns of Collaboration among Health Care and Social Services Providers in Communities with Lower Health Care Utilization and Costs Community approaches to reducing care utilization and costs. Peer-Reviewed Article September 2019
Going Beyond Clinical Care to Reduce Health Care Spending A regional approach to health care transformation. Peer-Reviewed Article July 2018
A New Hospitalist Model for Managing High-Cost, High-Need Patients A hospitalist model for complex care. Case Example October 2018
Impact of Primary Care Intensive Management on High-Risk Veterans’ Costs and Utilization Supplementing primary care with team-based management. Peer-Reviewed Article June 2019
Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community Reviews lessons from the Program of All-Inclusive Care for the Elderly on serving high-need populations in community settings. Case Example August 2016
Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats How to improve the cost benefits of case management. Peer-Reviewed Article August 2017
Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries Analyzes the largest drivers of high costs among persistently high-cost Medicare-Medicaid beneficiaries, and finds most spending related to long-term care. Peer-Reviewed Article October 2018
Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action This resource describes how academic medical centers can reshape the health system for patients with complex needs. Peer-Reviewed Article November 2018
The ROI Calculator for Partnerships to Address the Social Determinants of Health A web-based financial tool that helps navigate partnerships between health care organizations and social service organizations. Implementation Tool August 2018
Building Complex Care Programs: A Road Map for States This guide for state leaders offers lessons about state-level approaches to complex care. Implementation Tool October 2017
Care Management Contracting for Complex Populations: Best Practices and Tools This resource offers guidance on contracting for populations with complex needs. Implementation Tool July 2018
Medicaid Managed Care Best Practices Compendium This resource collects the most innovative initiatives in Medicaid managed care that emerge each year. Brief/Report January 2017
Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case This resource explains how to invest in social services as a business strategy. Implementation Tool March 2018
What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review A literature review describes the most important success factors for integrated care programs. Peer-Reviewed Article October 2017